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At least 19 recordsLinked to original sources
PubMed1994

Special care units for persons with dementia: expected and observed effects on behavioral symptoms.

Behavioral symptoms are common in nursing home residents with dementia, and have negative consequences for the residents, their families, staff members, and nondemented residents who live in close proximity to them. Special care units are intended to provide appropriate environments and methods of care that in turn are expected to reduce the incidence of behavioral symptoms. Studies of the effectiveness of special care units in reducing behavioral symptoms have had contradictory findings. Further research is needed to identify the particular environments and methods of care that are effective in reducing specific behavioral symptoms in these residents.

Aged↗
PubMed1997

Positive and negative symptom behaviors and caregiver burden in the relatives of persons with schizophrenia.

OBJECTIVE: The relationships of perceived severity and responsibility attribution for positive and negative symptom behaviors to caregiver burden were investigated. Two types of burden were studied: objective burden (i.e., negative consequences such as physical problems, financial difficulties, and household tension), and subjective burden (i.e., emotional distress about disturbing behaviors). METHOD: Self-report measures were completed by 70 primary caregivers of persons with schizophrenia. RESULTS: Subjective burden was related to both the severity of positive and negative symptom behaviors, whereas objective burden was related only to the severity of negative symptom behaviors. Responsibility attribution for negative symptom behaviors was related only to objective burden. Caregivers who perceived patients as being less responsible for their negative symptom behaviors reported higher levels of objective burden. The relationship between responsibility attribution for negative symptom behaviors and objective burden remained significant, even after controlling for the severity of negative symptom behaviors. Caregivers' perceptions of patients' responsibility for positive symptom behaviors were not related to objective burden. CONCLUSIONS: As expected, perceived severity of negative symptom behaviors was related to objective caregiver burden, whereas severity of positive symptom behaviors was not. These findings suggest that negative symptoms may have a greater impact on role functioning that positive symptoms, leading to greater burden. However, contrary to expectations, less responsibility attribution for negative symptom behaviors was related to higher levels of objective caregiver burden. Caregivers who perceive patients as incapable of altering their negative symptom behaviors and meeting certain role obligations may assume extra responsibilities, leading to higher levels of objective burden. The results indicate that there may be disadvantages for caregivers associated with assuming that patients have no control over their negative symptom behaviors.

Adult↗
PubMed1989

Management of the behavioral symptoms associated with dementia.

Dementia-related behavioral symptoms present a difficult management problem for caregivers and health care providers. The first step in the treatment of behavioral symptoms in the elderly should involve nonpharmacologic measures. This should include the exclusion of medication-induced dementia and delirium, which is an important consideration in the elderly owing to multiple medication use and alterations in pharmacokinetics and pharmacodynamics. Other measures involve relatively simple environmental changes. If these are unsuccessful, pharmacologic management is often tried. Numerous concerns surround the use of antipsychotics, which are the primary agents used to treat behavioral symptoms in demented elderly. The public is concerned about their inappropriate use as chemical restraints. Another concern involves the efficacy of these agents. Most well-designed studies demonstrate an overall modest effect from the antipsychotics that is often similar to that seen with placebo. There may be a small number of patients who respond markedly, whereas the majority do not receive great benefit. Unfortunately, all are exposed to the numerous side effects of these agents, including some irreversible movement disorders. If these agents are believed to be necessary, efforts should be made to use them in a manner that reduces the associated risks. A few other agents have been noted to successfully treat the problem behaviors associated with dementia, but most have been in the form of case reports. It appears that the optimal treatment of these problems relies on future research in the area of nonantipsychotic modalities that will be efficacious and have a rather benign side effect profile.

Aged↗
PubMed1998

Feasibility of retrospective assessments of behavioral symptoms in Alzheimer's disease: a preliminary study of postmortem caregiver reports.

Studies of the behavioral symptoms in Alzheimer's disease (AD) would be facilitated if reliable reports could be obtained retrospectively, especially about symptoms in the final months of life when concurrent assessment is often not feasible. To evaluate such a method, we compared results of a telephone interview conducted after the patient's death with information provided by the same informant earlier, while the patient was living. Agreement between in-life and retrospective assessments was higher for psychotic symptoms than for depressive behaviors, suggesting that retrospective assessment of specific behavioral symptoms in AD is not uniformly reliable. More symptoms were retrospectively reported as the length of time between the last in-life evaluation and date of death increased, suggesting that there may be increased variety of behavioral symptoms observed by caregivers in the final stages of the disease.

Aged↗
PubMed1995

Expanded cavum septi pellucidi and cavum vergae associated with behavioral symptoms relieved by a stereotactic procedure: case report.

CASE REPORT: A 6-year-old boy had symptoms such as unstable gait, behavioral symptoms, and irregular appetite, evacuation, and sleep. Giant cavum septi pellucidi and cavum vergae of 3 x 3 x 5 cm were revealed by computed tomography (CT) and magnetic resonance imaging (MRI). After stereotactic cyst-peritoneal shunting, regression of the cavities was revealed by CT and MRI, in association with marked improvement in the above-described symptoms. In the corpus callosum particularly, which had been preoperatively revealed on sagittal MRI sections to be extended circumferentially as a result of compression by a cyst; the compression was relieved postoperatively, and compression of the pericallosal brain tissue was also relieved. CONCLUSIONS: Compression of the brain tissue around the cyst (limbic system, etc.) was considered the most important cause of the behavioral symptoms in this patient.

Brain↗
PubMed2001

Emotional and behavioral symptoms in children with acute leukemia.

BACKGROUND AND OBJECTIVES: The diagnosis of leukemia is probably one of the most severe stressors that children can experience and may be associated with emotional and behavioral symptoms indicating comorbidity with mental health disorders. This study aims to evaluate the presence of emotional and behavioral symptoms in children with acute leukemia exposed to chemotherapy from outpatient services at two university hospitals in Brazil. DESIGN AND METHODS: In this cross-sectional study, emotional and behavioral symptoms were assessed using the Children Behavior Checklist (CBCL) in three groups of children aged 5-14 years: a) children with acute leukemia (n = 21); b) children with blood dyscrasias (n = 21); c) children evaluated or treated in a pediatric outpatient service (n = 33). RESULTS: Children with blood dyscrasias had significantly few symptoms of externalization (delinquent and aggressive behavior) than pediatric controls (p< 0.05). Children with leukemia did not differ from the two other groups regarding symptoms of externalization. No significant difference on the scores of the CBCL internalization dimension (anxiety, depression, somatic symptoms and withdrawn) was found among the three groups. INTERPRETATION AND CONCLUSIONS: These findings seem to indicate that children with acute leukemia do not have more emotional or behavioral symptoms than children with benign hematologic or physical diseases suggesting that comorbidity with mental disorders is not higher in children with acute leukemia than in children in the other two groups.

Acute Disease↗
PubMed1997

Clinical features and pharmacologic treatment of behavioral symptoms of Alzheimer's disease.

Behavioral symptoms are an integral component of Alzheimer's disease (AD) and an important cause of failure of home care. Well-chosen pharmacologic and psychosocial treatments can improve many of the distressing problem behaviors that occur in the course of the disease and, in some cases, may delay institutionalization. However, controlled trials remain scarce, and prediction of treatment outcome for individual patients is still uncertain at best. Recent improvements in the characterization of behavioral syndromes in AD hold promise for increasing the specificity of treatment choice and the predictability of response. This article reviews features of the major behavioral problems associated with AD and evidence for the effectiveness of existing treatments. We argue that the origins of behavioral disturbances include both intrinsic neurobiological aspects of the disease and environmental provocations, and present an approach to treatment decision-making that respects both the clinician's need to intervene to reduce suffering and the limitations of current knowledge.

Alzheimer Disease↗
PubMed1998

Genetic association between atopy and behavioral symptoms in middle childhood.

The relationship of atopic and behavioral symptoms in a community sample of 66 monozygotic and 141 dizygotic twin pairs, ages 4-11 years, was investigated via mother report questionnaires. Within-person correlation between atopic symptoms and Child Behavior Checklist internalizing symptoms (CBCL-INT) was .21 (p < .001) for the total sample. Cross-correlations between atopy and CBCL-INT were .26 for monozygotic and .04 for dizygotic twins. A common and specific factor model applied to the data revealed that the cross-correlation between atopy and CBCL-INT was mainly due to genetic influences (77% of the covariance). This study supports the hypothesis that there is a shared genetic risk for atopy and internalizing symptoms.

Analysis of Variance↗
PubMed2000

Stage-specific prevalence of behavioral symptoms in Alzheimer's disease in a multi-ethnic community sample.

The authors extended previous studies of the stage-specific prevalence of behavioral pathology to members of ethnic minority groups. Behavioral symptoms and their relationship to severity of Alzheimer's disease (AD) were examined in 125 heterogeneous minority elderly patients interviewed with a modified CERAD protocol, with behavioral symptoms scored on the caregiver-rated BEHAVE-AD Rating Scale. Behavioral disturbances were extremely common, occurring in 98% of the sample; the most common was activity disturbances (89%), followed by paranoid and delusional ideation (72%), aggressivity (64%), anxieties and phobias (61%), depressive symptoms (50%), sleep disturbances (43%), and hallucinations (34%). As in white patients, overall behavioral symptoms were most frequent among patients with moderate and severe dementia. Preliminary evidence supports the possibility of ethnic differences in behavioral profiles; Blacks showed lower affective, anxiety, and sleep symptoms than Asians and Hispanics, and lower total BEHAVE-AD scores than Hispanics. Inquiry in larger, population-based samples will be needed to determine whether the ethnic differences in behavioral symptoms of AD found here are robust and replicable.

Aged↗
PubMed1999

A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia.

OBJECTIVE: To compare effects of risperidone with placebo (efficacy and tolerability) and haloperidol (tolerability) for treating demented patients with aggression and other behavioral symptoms. METHODS: A 13-week double-blind study involving 344 patients with dementia randomly assigned to receive placebo or flexible doses (0.5 to 4 mg/d) of risperidone or haloperidol. Behavioral symptoms were assessed by the Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), the Cohen-Mansfield Agitation Inventory (CMAI), and the Clinical Global Impression (CGI) scale. Tolerability assessments included the Extrapyramidal Symptom Rating Scale, sedation levels, Functional Assessment Staging, Mini-Mental State Examination, and incidence of adverse events. RESULTS: The mean dose at endpoint was 1.1 mg/d of risperidone and 1.2 mg/d of haloperidol. Although not significant, a higher percentage of patients receiving risperidone than those receiving placebo showed clinical improvement (> or =30% reduction from baseline to endpoint in BEHAVE-AD total score) at endpoint and week 12. Reductions in the BEHAVE-AD total score were significantly greater with risperidone than with placebo at week 12. In a further analysis of aggression, the most dominant symptom in these patients, BEHAVE-AD and CMAI aggression cluster scores were significantly reduced compared with placebo at endpoint and week 12. CGI scores were also significantly reduced at endpoint and week 12. Severity of extrapyramidal symptoms with risperidone did not differ significantly from that of placebo and was less than that of haloperidol. A post hoc analysis showed significantly greater reductions in the BEHAVE-AD aggressiveness score with risperidone than haloperidol at week 12. CONCLUSION: Low-dose risperidone (mean 1.1 mg/d) was well tolerated and associated with reductions in the severity and frequency of behavioral symptoms, particularly aggression, in elderly patients with dementia.

Aged↗
PubMed1995

Behavioral symptoms in dementia: an update.

A descriptive literature review was done to identify research conducted in both community and institutional settings and published from 1986 to 1993 on the correlates of behavioral symptoms associated with dementia. Critical appraisal and synthesis of the 40 studies revealed theoretical and methodological problems that tempered conclusions about the relationships between behavioral symptoms and the correlates under study. While direct relationships were found in studies in which relationships between behavioral symptoms and cognitive impairment and contextual factors were examined, contradictory results were found in studies of demographic and functional variables. Recommendations for research-based practice are advanced, including the development and testing of alternatives to physical and chemical restraints in the care of persons with dementia.

Activities of Daily Living↗
PubMed1997

Assessment of behavioral symptoms in community-dwelling dementia patients.

The authors compared the CERAD Behavior Rating Scale for Dementia (CBRSD) with the Cohen-Mansfield Agitation Inventory (CMAI) for their ability to detect behavioral symptoms in community-dwelling dementia patients with mild-to-moderate global impairment. Both instruments were administered to caregivers of 33 cognitively impaired patients seen in a dementia clinic at initial evaluation or follow-up visit. Endorsement of a higher percentage of items on the CBRSD than the CMAI suggests greater sensitivity of this instrument to the behavioral symptoms seen in community-dwelling patients. There was good correlation between the number of items endorsed on both scales but not between subscales of the CMAI and factors of the CBRSD that appeared related to agitation. Thus, the CBRSD and CMAI both seem to measure behaviors that occur in dementia patients, but the CBRSD's two agitation-related factors do not appear to measure agitation as defined by the CMAI.

Activities of Daily Living↗
PubMed1996

Effect of tacrine on behavioral symptoms in Alzheimer's disease: an open-label study.

We conducted an open-label study designed to assess the effects of tacrine on behavioral changes in patients with Alzheimer's disease (AD). Twenty-eight subjects completed a baseline evaluation and at least one assessment during treatment. Behavioral symptoms and cognitive function were assessed with the Neuropsychiatric Inventory (NPI) and Mini-Mental State Examination (MMSE), respectively. The mean NPI score at the maximum individual dose of tacrine attained was markedly decreased (behavior improved, compared to baseline). Symptoms of anxiety, apathy, hallucinations, aberrant motor behaviors, and disinhibition were most responsive. Subject stratification by dementia severity revealed a substantially reduced mean NPI score only in the group with moderate dementia, independent of cognitive response. Over half of the subjects with cognitive improvement had a marked reduction in behavioral symptoms, particularly apathetic behaviors. These data suggest that tacrine may be beneficial for selected behavioral symptoms in AD patients, particularly at higher doses and in those with moderate cognitive deficits.

Activities of Daily Living↗
PubMed1997

Management of problematic behavioral symptoms associated with dementia: a cognitive developmental approach.

The purpose of this 3-year study was to test the efficacy of using a theoretical model based on Piaget's cognitive developmental stages for consistent behavioral and environmental interventions for persons at all stages of Alzheimer's disease and related disorders (ADRD) in nursing home and special care units. The specific aims were to reduce problematic behavioral symptoms and the number, amount and frequency of use of psychotropic medications. After 18 months, problem behaviors and some types of psychotropic medications significantly decreased in the treatment group but not in the control group. Results of the study indicate that using behavioral and environmental interventions based on Piaget levels of cognitive development may be an effective method of managing problematic behavioral symptoms and decreasing the use of psychotropic medications in institutionalized ADRD patients.

Aged↗
PubMed1994

Culture-fair behavioral symptom differential assessment and intervention in dementing illness.

Ethnically diverse populations are not represented in the dementia-related noncognitive behavioral symptom research arena. Some of the obstacles are structural, centering around the lack of inclusion of ethnic minority groups within existing projects. These impediments are surmountable by the systematic targeting and incorporation of ethically diverse populations in research and the deployment of a variety of research-related outreach approaches. The more formidable barriers are conceptual. They relate to the need to differentiate cultural factors from socioeconomic and social status (SES) artifacts and to include life-long exposure to various forms of prejudice and discrimination, all of which can come together in the late-life manifestation of behavioral symptoms. A culture-fair behavioral assessment and intervention model is presented. It allows researcher and clinician alike access to ethnocultural data, while differentiating SES influences. A comparative Hispanic/Anglo dementia caregiver pilot study has provided a partial test of the model with statistically significant outcomes. Two-tailed t tests (p < or = 0.05) uncovered ethnic group differences with respect to four specific dimensions of caregiving. The differences were demonstrated around reactivity to caregiving burden, caregiver health status, coping and helpseeking styles, and configuration of social support received from social network members. Further multiple regression analysis sustained the observed differences despite income, education, and mean age variance between the two ethnic groups. The model has an overall multicultural applied intent. More study is indicated.

Acculturation↗
PubMed1987

Behavioral symptoms in Alzheimer's disease: phenomenology and treatment.

Limited information is available regarding the incidence, nature, and treatment of behavioral problems in Alzheimer's disease (AD). A chart review of 57 outpatients with a diagnosis of AD was conducted to examine these issues. Thirty-three (58%) patients had significant behavioral symptomatology (most commonly delusions, nonspecific agitation, and diurnal rhythm disturbances). Twenty-seven were treated with thioridazine (10-250 mg/day), 15 (55.6%) of whom were judged to have a positive response (mean maximum dose = 55 mg/day). Information regarding the characteristic phenomenology of the behavioral symptoms studied was used to design a clinical rating instrument for AD patients, the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), which should be useful in prospective studies of behavioral symptoms as well as in pharmacologic trials.

Aged↗
PubMed1989

Perceptions of control, competence, and contingency as influences on the stress-behavior symptom relation in school-age children.

Analyzed data from 154 school-age children and their mothers to examine the relations between stress, perceived competence and contingency, and behavior symptoms. Analyses focused on the relative merits of unidimensional vs multidimensional measures of control in predicting symptoms. The stress of undesirable life events and behavior symptoms were related in the expected direction. Multiple regression models with R2 ranging from .11 to .14 (all ps less than .0002) included significant main effects for stress, competence, and control. Analyses supported the relative superiority of the multidimensional measure of control. Models containing main effects and interaction terms were of equivalent magnitudes in accounting for variance in symptom scores. Findings support the idea of perceived control as a moderator of the stress-illness relation and are consistent with earlier suggestions that simple main effects models may be the most useful in examining these relations.

Achievement↗
PubMedDate not supplied

The biological basis of behavioral symptoms in dementia.

This article describes the pathophysiology of dementia and differentiates between cognitive and noncognitive symptoms that characterize this devastating illness. Relationships between brain anatomic and neurochemical systems and behavioral symptoms of dementia are discussed. An overview of the etiologies and neuro-pathologies of dementia are presented as they relate to impairments in memory and intellectual abilities, personality changes, and behavioral symptoms. Recent genetic and molecular discoveries that have advanced our understanding of this complex spectrum of disorders and their treatment(s) are also highlighted.

Anti-Inflammatory Agents, Non-Steroidal↗